White House pressures GOP leaders on Obamacare showdown next week

A frantic and impatient White House is pressuring House GOP leaders for another showdown vote on repealing Obamacare next week so it can notch a legislative win before President Donald Trump’s first 100 days in office.

But while the outlines of a possible deal are starting to come together, it’s far from clear that House Republican leaders have found the sweet spot to pass their embattled alternative health plan.

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The White House does not schedule House floor votes. And while some senior administration officials suggested Thursday that a vote will occur next week, multiple House GOP sources told POLITICO that is unlikely.

Indeed, the vote is not currently on the calendar. Nor do Republican insiders think it’s even possible, as Congress will reconvene Tuesday after a two-week Easter recess. That would leave them with one day to whip votes — an unlikely time frame for such a heavy legislative lift.

“The question is whether it can get 216 votes in the House, and the answer isn't clear at this time,” a senior GOP aide said. “There is no legislative text and therefore no agreement to do a whip count on.”

The conflicting narratives suggest top administration officials and House Republican leaders are either miscommunicating — or, more likely, that White House sources are squeezing Speaker Paul Ryan and his team, telling them to move quickly. Notably, the same senior White House officials who suggested a vote would occur next week also said the text of a new deal will likely be circulated Friday "or by the weekend."

The claim perplexed some GOP insiders who don’t expect legislative text for a few days, at the earliest.

The back-and-forth highlights just how impatient Trump is growing with Congress. Administration officials are feeling inordinate pressure to advance the legislation out of the House, fearing that failure to repeal the health care law will dominate coverage of the administration's first 100 days, which end next week, officials say.

Trump on Thursday predicted that health care legislation would pass "next week or shortly thereafter.” During a joint news conference alongside Italian Prime Minister Paolo Gentiloni, the president also took issue with the characterization that Republicans gave up on health care after they pulled the original House bill. He reminded reporters that Obamacare was roughly a year-and-half-long effort, while he said he’s only had about two months to negotiate a better deal.

But multiple House GOP insiders say the White House doesn’t understand how Congress works, and just because Trump officials say there will be a vote next week doesn’t make it so. GOP leaders cannot whip votes until legislative text is actually written, and it will be tough to get a good sense of where the conference stands until members return to town on Tuesday.

GOP leaders have their work cut out for them in the meantime. While the White House believes it is "close" to having the 216 votes needed to get a bill out of the House, one senior official said, others on Capitol Hill aren't nearly as confident.

Insiders say the deal could probably deliver between 15 to 20 conservative House Freedom Caucus members who were previously "no" votes, so long as the text says exactly what was agreed to. But moderates — and more than a few traditional Republicans — say the deal is bad policy.

Indeed, several centrist sources were incensed that Tuesday Group co-chair Tom MacArthur, the top negotiator for the moderates, agreed to the changes without getting the backing of his group. They're not sure he can deliver the votes.

"The amendment doesn't address the things that I had concerns about — the things I think are detrimental to the people I represent," said Rep. Dan Donovan, a centrist New York Republican who is currently a "no" on the bill.

Donovan said there has been little to no Tuesday Group coordination on the negotiations, and he was skeptical that the deal would move any moderate votes.

The White House began ramping up pressure on GOP leaders two weeks ago, when top Trump officials called Ryan to the White House and chided the Wisconsin Republican for not delaying recess until a deal was struck.

Since then, the White House has worked with Freedom Caucus Chairman Mark Meadows (R-N.C.) and MacArthur (R-N.J.) to come up with a deal they hope will pick off enough conservatives and moderate support to pass the House.

Trump, meanwhile, has asked repeatedly — sometimes several times a day — about the status of the health care law and seems more engaged than during last month's failed effort to get Ryan’s American Health Care Act through the chamber, a senior administration official said. The president believes that it will be difficult to gain momentum on other issues without "getting something done on health care," according to one person who spoke with him. OMB Director Mick Mulvaney separately said Thursday the White House is ready to negotiate with Democrats on adding key Obamacare insurance cost-sharing subsidies to a fiscal 2017 spending bill to keep the government running -- if Democrats agree to pay for some of Trump’s priorities,such as defense and border security money.

According to a draft of the tentative deal obtained by POLITICO, the latest proposal would allow states to apply for "limited waivers" that would undermine Obamacare's protections for pre-existing conditions. Under these waivers, states could opt out of Obamacare standards setting minimum benefits that health plans must offer and a requirement — called community rating — forbidding insurers from charging different prices to people based on health status.

Both are provisions that the GOP’s ultraconservatives have pushed to eliminate as part of the repeal effort, contending that these coverage mandates drive up the cost of insurance. States opting out of the community rating rules would be forced to set up an "invisible risk-sharing" program aimed at providing a backstop to health plans while preventing sicker patients from being priced out of the market. The hope is that protecting insurers from the most expensive customers will bring down the costs for the rest of the risk pool. That will allow insurers to lower premiums, which in turn will entice more customers into the individual market.

At the same time, the deal would allow states the option of maintaining insurance protections, supported by centrist Republicans, including community rating.

While the changes will likely win over some conservatives, leaders will have a problem with their centrists. MacArthur said in a statement Thursday that he has insisted during the discussions that any compromise have protections for individuals with pre-existing conditions. But many of his like-minded colleagues believe he did not keep that promise under the current agreement.

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Many centrists don’t approve of MacArthur’s negotiating tactics. While Meadows has made a point of ensuring that any potential changes he negotiates will likely get a green light from his members, some Tuesday Group members do not feel MacArthur has done the same.

Moderates and a few traditional Republicans believe the legislative changes will hurt people with pre-existing conditions, a population they vowed to protect on the campaign trail. But since GOP leaders are feeling the heat from the White House, they may have to put the changes on the floor regardless.

House Republicans will likely discuss the latest changes during a Saturday telephone conference call. The call, however, is routine during recess and was actually announced last week — well before the White House, MacArthur and Meadows publicized the new accord.

The renewed effort also comes just days before the high-stakes deadline over funding the government or shutting it down over contentious issues — including whether Republicans will fund a key Obamacare subsidy program, financing for Trump’s border wall and boosting military spending, among others.

Trump and some administration officials have threatened to cut off Obamacare cost-sharing subsidies — a decision that would wreak havoc on the Obamacare insurance exchanges — in a bid to get Democrats to negotiate on a replacement plan.

Those subsidies, which are at the center of a court battle begun under the Obama administration, help lower-income people pay medical bills and insurance deductibles. Taking them away would prompt insurers to either flee the market or severely hike premiums to cover those costs. Despite calls from the health care industry, business groups and Democrats to continue the payments, the White House has yet to tip its hand.